Procedures › Joint arthroscopy

Anaesthesia for joint arthroscopy

This page covers the anaesthetic, nerve block options, pain relief and recovery for keyhole joint arthroscopy, including knee, shoulder and ankle procedures. Your own plan is agreed with you before surgery.

Before surgery

Joint arthroscopy is a minimally invasive ("keyhole") procedure used to diagnose and treat problems inside a joint. Common examples include knee meniscal surgery, ankle impingement surgery, shoulder labral repair, and removal of loose bodies. Although arthroscopy uses small incisions, the joint itself can still be sensitive for a few days. We use a structured pain management plan to keep you comfortable during recovery.

• Fasting: No food for 6 hours before surgery. Clear fluids (water, black tea/coffee without milk, clear apple juice) are allowed until 2 hours before.
• Medications: Most regular medicines should be taken as usual unless advised otherwise. Blood thinners and some diabetes medications may require adjustments.
• Pre-operative consultation: I may contact you before surgery to discuss the anaesthetic plan and answer any questions if you would like this.

See our fasting guidance and medicines before surgery page for more detail.

Anaesthetic plan

Most joint arthroscopies are performed under a general anaesthetic (GA).

• General anaesthetic (GA) - You will be fully asleep and unaware of the procedure.
• Nerve block (in selected cases) - Depending on the joint and the type of surgery being performed, I may perform a nerve block using ultrasound guidance. This provides additional pain relief after surgery and can significantly reduce the need for strong opioid medicines. Examples include:
  • Adductor canal block for knee surgery.
  • Sciatic nerve block for foot and ankle procedures.
  • Interscalene block for shoulder surgery.
• Local anaesthetic from the surgeon - Additional numbing medicine is placed into the joint and tissues by your surgeon at the end of surgery.

The anaesthetic approach is tailored to the specific procedure and your medical background.

Medications during surgery

• Strong pain relief (opioids): Medicines such as opioids are given through your drip during the operation and in post anaesthesia unit if needed.
• Dexamethasone (Dex): A steroid given during surgery to reduce inflammation, improve comfort, and reduce nausea.
• Intravenous Parecoxib: An anti-inflammatory medicine given during surgery to reduce pain and swelling.
• Antiemetics: Medicines are also given to reduce the chance of nausea or vomiting afterwards.

After surgery

Regular pain relief (first 5 days)

• Paracetamol is usually taken regularly for several days.
• An anti-inflammatory medication may be prescribed if appropriate.

Additional pain relief

• Stronger pain medicines may be prescribed for short-term use if required.
• The exact combination depends on the type of surgery performed and your expected pain level.
• Nausea relief medication may also be provided if needed.

All prescriptions are individualised to balance comfort with safety and minimise side effects.

Recovery and pain expectations

• Pain severity depends on the procedure performed.
• Simple clean-up procedures often cause mild to moderate pain for a few days.
• More extensive procedures such as ligament repair, cartilage surgery or labral repair may cause moderate discomfort for 1-2 weeks.
• Swelling and stiffness are common.
• If a nerve block is used, this may provide pain relief for the first 12-24 hours.
• Pain usually improves steadily over the first 1-2 weeks.
• Physiotherapy and early movement are important for recovery.

Side effects

• Temporary leg weakness or numbness while the block is working.
• Drowsiness or nausea from stronger pain medicines - these are monitored and treated if they occur.
• Constipation can occur if opioids are needed - this is preventable with simple measures.

Consent for nerve blocks

In some cases, a nerve block may be recommended to improve pain control after surgery. A nerve block involves injecting local anaesthetic near specific nerves using ultrasound guidance. This temporarily numbs part of the limb and can significantly reduce the need for stronger pain medicines.

Benefits may include:

• Better early pain control.
• Reduced nausea from opioid medicines.
• Earlier mobilisation.

As with all medical procedures, nerve blocks carry potential risks. These include:

• Temporary numbness or weakness.
• Incomplete pain relief.
• Bruising or bleeding.
• Infection (rare).
• Nerve irritation or prolonged numbness (very rare).

In extremely rare cases, more serious complications can occur.

Alternatives include:

• Proceeding without a nerve block and using tablet or intravenous pain medicines alone.
• Local anaesthetic placed by the surgeon into the joint.
• A different nerve block technique where appropriate.

You are always free to decline a nerve block.

Safety and monitoring

• You must not drive, operate machinery or make important decisions for 24 hours after a general anaesthetic.
• Your pain relief will be reviewed before discharge.
• You will receive written instructions about medications and when to seek medical advice.
• All techniques and medicines used are standard practice and tailored to you.